Jonker Leon, Fisher Stacey Jayne, Dagnan Dave
Research and Development Department, Cumbria Partnership NHS Foundation Trust, Carlisle, UK.
J Eval Clin Pract. 2020 Feb;26(1):203-208. doi: 10.1111/jep.13118. Epub 2019 Feb 19.
RATIONALE, AIMS AND OBJECTIVES: Clinical research activity in hospitals is associated with reduced mortality and improved overall care quality. In England, the latter is a compound score of several elements and both staff and inpatient feedback form part of the Care Quality Commission (CQC) ratings. The objective of this study was to determine if NHS Trusts' National Institute for Health Research (NIHR) study activity data correlates with specific outcomes from national NHS staff and patient surveys.
Retrospective cohort design involving data for 129 English NHS hospital Trusts, including scores from recent national NHS staff and inpatient surveys and NIHR data. Statistical approach involved Spearman correlation analyses, with cut-off P value ≤ 0.01 for qualification for subsequent principal component analysis (correlation coefficient cut-off value 0.20).
Outcomes of one staff survey question (staff recommendation of the organization as a place to work or receive treatment) and multiple outcomes of inpatient survey questions were positively associated with increased NIHR-adopted clinical research activity. Better quality of information provision to patients was the dominant theme, though a higher degree of observed staff teamwork, more confidence in the treating doctors, and a better overall inpatient experience also correlated significantly. The number of different studies contributed more to positive associations with survey outcomes compared with the number of recruited participants into research.
Survey elements of the CQC appraisal of English NHS Hospital Trusts are significantly associated with increased clinical research activity levels; it appears to drive better information provision to inpatients-particularly around medicine management-and contribute to a better inpatient experience overall, whilst staff are more likely to recommend their own organization. Despite clinical research activity forming a very small fraction of overall NHS activity, it has an indirect positive effect on staff and Trust performance that is measurable at patient level.
原理、目的和目标:医院中的临床研究活动与降低死亡率及提高整体护理质量相关。在英国,后者是由多个要素构成的综合评分,员工和住院患者的反馈均是护理质量委员会(CQC)评级的一部分。本研究的目的是确定国民健康服务体系(NHS)信托机构的国家卫生研究院(NIHR)研究活动数据是否与NHS全国员工和患者调查的特定结果相关。
采用回顾性队列设计,涉及129家英国NHS医院信托机构的数据,包括近期NHS全国员工和住院患者调查的得分以及NIHR数据。统计方法包括Spearman相关性分析,后续主成分分析的合格P值截断为≤0.01(相关系数截断值为0.20)。
一项员工调查问题的结果(员工推荐该机构作为工作或接受治疗的场所)以及住院患者调查问题的多个结果与NIHR采用的临床研究活动增加呈正相关。向患者提供更好的信息质量是主要主题,不过观察到的更高程度的员工团队合作、对主治医生的更多信心以及更好的整体住院体验也显著相关。与研究招募的参与者数量相比,不同研究的数量对与调查结果的正相关贡献更大。
英国NHS医院信托机构CQC评估中的调查要素与临床研究活动水平的提高显著相关;它似乎能推动为住院患者提供更好的信息——尤其是在药物管理方面——并有助于整体改善住院体验,同时员工更有可能推荐自己所在机构。尽管临床研究活动在NHS的整体活动中占比非常小,但它对员工和信托机构的表现有间接的积极影响,这种影响在患者层面是可衡量的。